SHAFAQNA – 13th January 2015 – Health charities have reacted with dismay following an announcement that 25 cancer treatments are to have their funding withdrawn by the NHS in England. The decision was made during a review of the Cancer Drugs Fund.

NHS England says difficult decisions had to be made after it emerged that the fund, set up to give patients access to medications not routinely available on the NHS, is over budget.

Some medications will be removed from the list altogether while others will be restricted to certain cancers.

NHS England says the changes, due to come into effect on the 12th March, will allow some new drugs to join the list. It has also stressed that patients currently receiving the treatments will be allowed to continue having them.

Budget problems

The budget for the Cancer Drugs Fund grew from £200 million in 2013-14 to £280 million the following year. It is estimated that the budget will grow to £340 million for the financial year starting in April 2015.

NHS England says the changes it has announced will produce savings of approximately £80 million. It says that without the review the fund would have grown to £420 million next year and would have led to cuts in other areas of cancer treatment such as radiotherapy, diagnosis and surgery.

Oncologists, pharmacists and patient representatives assessed each medication on the list as well as new drugs to check their cost effectiveness. In cases where the cost was considered too high, the manufacturers were given the opportunity to cut prices.

‘Difficult decisions’

Professor Peter Clark, chair of the Cancer Drugs Fund and a practising oncologist, says in a statement: “We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound.

“There were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those. There were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments.

“These are difficult decisions, but if we don’t prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline.”

New treatments

The review means that 59 out of the 84 cancer treatments will stay on the fund’s list next year. The exclusions mean that some new treatments will become available for funding. These include panitumumab, a treatment for bowel cancer, ibrutinib, a treatment for Mantle cell lymphoma, a type of non-Hodgkin lymphoma, ibrutinib for use in chronic lymphocytic leukaemia (CLL).

However, charities and patients’ representatives have complained that the changes will leave many people struggling to find treatments. Bowel Cancer UK says 5 treatment options for colorectal cancers involving 3 medications will no longer be funded by the NHS. The drugs affected are aflibercept (Zaltrap), bevacizumab (Avastin) and cetuximab (Erbitux). Aflibercept has been removed from the Cancer Drugs Fund completely, while bevacizumab and cetuximab have had their availability reduced.

Nick Bason, head of policy and communications at Bowel Cancer UK, says in a statement: “Decisions about drugs already available via the Cancer Drugs Fund appear to have been made in haste without any proper consideration of the real-world benefits that these drugs have for patients themselves in terms of both extension and quality of life.”

The manufacturer Eisai said it was “aghast” by the decision to remove eribulin (Halaven) from the list. It described the medication as one of the lowest priced cancer treatments in the fund with a proven track record of extending the lives of women with secondary breast cancer.

Samia al Qadhi, chief executive of the charity Breast Cancer Care, commented: “The Cancer Drugs Fund is falling apart when there is still no long-term solution in place.”

Prostate Cancer UK said the Cancer Drugs Fund was in “meltdown” after hearing that cabazitaxel (Jevtana) was to be struck off the list. Chief executive Owen Sharp said in a statement: “It underlines yet again the critical need for a more effective overall solution to the commissioning of cancer drugs across the whole of the UK.”

The drug’s manufacturer, Sanofi, said the delisting meant patients with hormone resistant advanced prostate cancer would be left with no treatment options following initial chemotherapy.

Today brought more unwelcome news for patients with prostate cancer after the National Institute for Health and Care Excellence (NICE) signalled that it would not recommend sipuleucel-T (Provenge) for routine use on the NHS.

Sipuleucel-T was developed for treating people whose disease has spread, who have few symptoms and where chemotherapy has not yet become an option.

In final draft guidance, NICE said the cost of the medication outweighed its benefits.